Focus on Fitness: From Walking to Running
By Kelly Jones, MS, RD, CSSD, LDN
Today’s Dietitian
Vol. 25 No. 4 P. 46

Today’s Dietitian speaks with experts on the benefits and risks of running and how to create a walk-to-run program to get clients started.

It’s common for RDs to discuss fitness goals with clients, even if they’re not working in the performance nutrition space. With goals to improve heart health, manage blood sugar, enhance bone density, and more, the subject of running may come up in conversation during counseling sessions with clients who already prioritize movement. While dietitians want to support their ambitions, it’s important to help clients weigh the benefits and risks, understand what a healthy progression to running looks like, and refer to proper medical professionals if necessary. This article explores how dietitians can effectively do just that.

Benefits of Walking
Modern American lifestyles have become more sedentary, but with some intention, regular walking can benefit short- and long-term health. A study following several thousand adults found that reaching 7,000 steps per day was the point where the risk of premature death decreased by 50% to 70%.1 While that’s a long-term benefit, there also are short-term benefits. Simply getting outside, especially in green environments, has been shown to improve mood and reduce stress. So walking outside when possible, as opposed to indoors on a treadmill, may have enhanced benefits for mental health.2

Not all people will want or be able to run, and starting a walk-to-run program may not be feasible specifically for older adults, especially if they’ve never run in the past. For this population, brisk walking may improve cardiorespiratory fitness and muscular strength.3 With less impact than running but more than with water-based exercise, it also can benefit those with osteoporosis. The bone-protective benefits of walking also have been observed in premenopausal women who walk for 30 minutes three or more days per week.4

Benefits of Running
While walking has its advantages, those who are short on time may benefit most from running. Physical therapist Jenn Perna, PT, DPT, OCS, owner of Vivid Women’s Health (, @vividwomenshealth) in Newtown, Pennsylvania, says that from a cardiopulmonary and musculoskeletal perspective, running is more physically demanding. “This means you can get a better workout over a shorter time from a run.”

Ryan Miller, USAW, FMS, a personal trainer and functional movement specialist also in Newtown, agrees, noting that running can optimize physical functionality as well as internal health. “Running further increases maximal oxygen consumption (a measurement for cardiorespiratory fitness), and with proper technique, can optimize biomechanical movements,” he says. “The latter may translate to better physical functioning for both exercise and movements of daily living.”

Most dietitians know that strength training and plyometrics are positive stressors benefiting bone strength, but running may not be the first plyometric movement that comes to mind. Perna emphasizes that “The compressive loads that running places on our bones and joints provides greater benefit to our musculoskeletal system. This is especially important as we consider declines in bone mineral density as we age. As a plyometric exercise, it’s great for our tendon and muscle health, which also decline with age.”

It’s worth noting that at any age, adequate energy availability is critical to maintain hormone levels that support bone growth. Low energy availability in active individuals is shown to decrease bone mineral density and increase risk of bone stress injuries.5 So discuss the importance of eating enough energy throughout the day that will support clients’ intense level of physical activity.

Finally, the mental health benefits of running may be greater than that of walking. High intensity exercises, such as running, not only stimulate endorphin release (the “runner’s high”), but it’s been suggested that this release may stimulate adult neurogenesis, or the development of new functional neurons.6

Challenges to Running
What seems like a natural movement may require training on form, plus cardiorespiratory and musculoskeletal clearance from the client’s doctor. Remind clients that they can only reap the benefits of running if they aren’t injured or putting their heart health at greater risk. As dietitians, we know the importance of cardiac rehab programs and clearance for training programs after cardiovascular events. However, Perna says, “From an orthopedic perspective, recent surgeries and fractures are contraindications to beginning a walk-to-run program, especially if those injuries are new (within the last six to eight weeks).”

Even if clients receive clearance from a general practitioner, if they’re not seeing an orthopedic specialist, physical therapist, or personal trainer who specializes in functional movement, there are some things they’ll need to consider before beginning a walk-to-run program.

Perna says the immediate postpartum period is a relative contraindication, even in clients who ran before and during pregnancy. “Research shows that we need to wait until after 12 weeks postpartum to start running regardless of delivery method.7 The pelvic floor goes through an immense amount of stress during pregnancy and before this point, it isn’t adequately able to withstand running’s compressive forces.” Women may feel pressured to exercise intensely due to body image concerns that frequently arise after delivering a baby, so it’s critical for health care providers to encourage new mothers to eat adequately and focus on taking care of mental health and the baby’s development.

Even without a previous injury, if clients increase their running volume too quickly or without an evaluation of form, they may be at increased risk of injury. “If biomechanics are off, there may be underlying muscular weakness, or if duration and distance increase without appropriate programming, this can create weaknesses in running gait,” Miller says. “That may boost the likelihood of obtaining plantar fasciitis, straining the Achilles tendon, developing various forms of knee pain, and straining the lower back.”

Support Running Progression With Cross Training
A walk-to-run program is important for anyone new to or returning to running, but other types of movement can support major muscle groups and reduce the risk of injury. “Running should never be painful,” Perna says. “It should feel pretty natural and if it’s a struggle, it might cue that your body isn’t ready for this type of activity.”

Perna also says one of her concerns is when clients are interested only in running as their physical activity of choice. She says a strength training routine is important, adding that “We have to get strong to run, not run to get strong,” while emphasizing the importance of good leg, hip, and core strength, and mobility, especially when standing on one leg. What else do physical therapists consider? Type of shoes, running surface (eg, treadmill, track, pavement, trail, etc), terrain (eg, flat, incline, decline), and more. Modifying any of those variables can affect pain.

Miller adds, “Resistance training can support running and overall health goals by increasing strength and stability as well as range of motion. It has the opportunity to aid in injury prevention, increase recovery rate, and reduce imbalances between muscles used for running.” Before beginning a walk-to-run program, he recommends having one’s running gait evaluated by a professional and suggests foam rolling and dynamic muscle activation before each run.

Recommended Walk-to-Run Program
Perna offers a framework for the walk-to-run programs she provides clients, whether they’re new to running or returning postinjury or postpartum. However, she says clients should consult with their physicians before beginning a walk-to-run program, as this is especially important for those with heart disease or circulatory problems and those who present with healthy biometrics but have a recent or lingering musculoskeletal injury.

With a walk-to-run program, Perna suggests alternating intervals of running with intervals of walking for a total of 10 to 20 minutes, depending on the client. She recommends repeating these intervals two or three days per week, then, if the client is feeling well, increasing the length of the running interval the following week. Below is an example of how this might look for patients at Perna’s practice, after a warmup:

Week 1: One minute of running followed by one minute of walking.
Week 2: Progress to two or even three minutes of running followed by one minute of walking.
Week 3: May increase to five minutes of running followed by one minute of walking.
Week 4: Up to 7.5 minutes of running followed by one minute of walking.
Week 5: As many as 10 minutes of running, followed by one minute of walking.

For those who feel like a full minute of running is too much, Miller says that 30 second running intervals may be more comfortable to start. Beginners also may progress by adding only one minute to their running intervals each week.

— Kelly Jones, MS, RD, CSSD, LDN, is a board-certified specialist in sports dietetics, who consults with national sports organizations, and a media and nutrition communications expert. Her private practice works with individuals and groups while offering practical resources to support performance for athletes at every level. She also founded and oversees Student Athlete Nutrition.

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3. Bai X, Soh KG, Omar Dev RD, Talib O, Xiao W, Cai H. Effect of brisk walking on health-related physical fitness balance and life satisfaction among the elderly: a systematic review. Front Public Health. 2022;9:829367.

4. Lan YS, Feng YJ. The volume of brisk walking is the key determinant of BMD improvement in premenopausal women. PLoS One. 2022;17(3):e0265250.

5. Mountjoy M, Sundgot-Borgen JK, Burke LM, et al. IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. Br J Sports Med. 2018;52(11):687-697.

6. Schoenfeld TJ, Swanson C. A runner's high for new neurons? Potential role for endorphins in exercise effects on adult neurogenesis. Biomolecules. 2021;11(8):1077.

7. Selman R, Early K, Battles B, Seidenburg M, Wendel E, Westerlund S. Maximizing recovery in the postpartum period: a timeline for rehabilitation from pregnancy through return to sport. Int J Sports Phys Ther. 2022;17(6):1170-1183.